title: Longitudinal association of depressive symptoms with rapid kidney function decline and adverse clinical renal disease outcomes.
abstract: OBJECTIVE
  Depression is a risk indicator for adverse outcomes in dialysis patients, but its prognostic impact in individuals who are not yet on dialysis is unknown. This study examines whether depressive symptoms are longitudinally associated with renal function decline, new-onset chronic kidney disease (CKD), ESRD, or hospitalization with acute kidney injury (AKI).
  
  
  METHODS
  Depressive symptoms were measured in a longitudinal cohort study with the 10-item Centers for Epidemiologic Studies Depression scale using a previously validated cut-off value (≥8). CKD at study entry and during follow-up was defined as an estimated GFR (eGFR) < 60 ml/min per m(2). Outcomes were rapid decline in eGFR (>3 ml/min per m(2) per year), new-onset CKD, ESRD (U.S. Renal Data System-based), and AKI (based on adjudicated medical record review). The median follow-up duration was 10.5 years.
  
  
  RESULTS
  Depressed participants (21.2%) showed a higher prevalence of CKD at baseline compared with nondepressed participants in multivariable analysis. Depression was associated with a subsequent risk of rapid decline in eGFR, incident ESRD, and AKI, but not incident CKD in unadjusted models. In multivariable analyses, only associations of depressive symptoms with AKI remained significant.
  
  
  CONCLUSIONS
  Elevated depressive symptoms are associated with subsequent adverse renal disease outcomes. The depression-related elevated risk of AKI was independent of traditional renal disease risk factors and may in part be explained by the predictive value of depression for acute coronary syndromes and heart failure hospitalizations that can be complicated by AKI.
authors.affiliation: Department of Medical Psychology and Neuropsychology, Center for Research on Psychology in Somatic diseases, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands. w.j.kop@uvt.nl
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Kop
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Seliger
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.forename: Linda F
authors.initials: LF
authors.lastname: Fried
authors.forename: Dena E
authors.initials: DE
authors.lastname: Rifkin
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.forename: John S
authors.initials: JS
authors.lastname: Gottdiener
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male